Mental health patients are being sent up to 80 miles away for “poor quality” care due to bed shortages at mental health trusts that have cut back on capacity, an inquiry has found.
The report from a year-long inquiry by the Schizophrenia Commission into care for people with psychosis also warns that many inpatient units regularly breach recommended bed occupancy levels, are over-reliant on agency staff and are “stressful, chaotic and scary places” for service users.
The commission, set up by charity Rethink mental illness and comprised of 14 experts including health and social care professionals and service users, recommends a “radical overhaul” of poor acute mental health care. It said it was aware of “some excellent” crisis services but admitted that too many are “frightening, un-therapeutic and lacking compassion”.
Of 2,500 people surveyed by the commission, four in 10 mental health professionals and 35% of service users said reform of acute services should be a priority.
Issues with acute care identified in the report include:
- Cuts to inpatient beds in some trusts have been so severe that they “have to send patients away to poor quality provision as much as 80 miles away”.
- A “pervasive gloom” in poor inpatient units is hampering efforts to recruit social workers, nurses and doctors to mental health teams.
- Patients who remember poor quality care at hospitals and have relapsed are refusing hospital admissions and instead being detained under the Mental Health Act.
- Incidents of violence, theft and sexual harassment against staff and patients are being reported in some services.
- The constant stress of dealing with very disturbed patients is causing nurses to burn-out.
- There are issues with temporary workers. The panel heard that “temporary staff often hide in offices, shy away from talking to patients and even appear to lack basic essential caring qualities”.
Daisy Bogg, a mental health social worker and approved mental health professional, warned that sending people out-of-area could affect the level of care provided.
“It is distressing for service users and their families and is generally far more expensive. It’s happening more and more. While it’s not the case that every person is sent out-of-area it’s an ever present concern,” said Bogg.
“I worry that it goes against the guiding principles of the Mental Health Act in terms of participation and respect. If you stick someone out-of-county surely you lose that?”
The wide-ranging report examines the quality of care for psychosis and schizophrenia across mental health services.
It calls on local authorities and NHS trusts to promote personal budgets for people with schizophrenia and psychosis. Only 14 percent of people receiving mental health social care support are receiving self-directed support, compared with a 43 percent average for all people receiving social care services.
Jonathan Philips, former chair of the Association of Directors of Adult Social Services mental health network and a member of the commission, said: “This is compounded by the lack of awareness of the usefulness of direct payments and is an indication of the need to change the culture in mental health services so that people are more in control of their lives.”
The report also warns that social workers need to defend the social model of mental health care amid the threat of it being “eclipsed” by a medical approach to care.
“We heard far too many cases where the social element has been lost in treatment and support planning,” the commission found.